In making clinical decisions based on data, one must have data of sufficient quality to make a decision. Expert opinions, clinical experience and tradition have a place but they must be supported by data. Polit & Beck (2008) state “best evidence refers generally to findings from research that are methodologically appropriate, rigorous and clinically relevant” (p. 32). Going to the data and reviewing the source is one way to assess the quality. Decision support is based on best practice evidence.If that best practice data is bad, then the decision support is bad, and the patients’ care has the potential to be worse then it would have been with tradition and experience. Quality data is the backbone of decision support. When decision support is reliable, it has the potential to “be effective in assisting nurses with guideline-adherent care and improve[e] patient outcomes” (Anderson & Willson, 2008, p. 157).

Anderson, J. A., & Willson, P. (2008). Clinical decision support systems in nursing: Synthesis of the science for evidence-based practice. Computers, Informatics, Nursing 26(3) 151-158.

Polit, D. E., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice (8th ed) Philadelphia: Wolters Kluer/Lippincott, Williams & Wilkins.

Module 4, Question 1

When making a clinical decision I recall information I have learned from school and work and then go with my educated gut instinct. In reading about heuristics I now realize my gut instinct is less likely to be right than I thought. Given that only a small percentage of nursing care is actually supported by evidence, the whole profession of Nursing uses a lot of heuristics and biases when making clinical decisions. Reading these articles has helped me realize that I may not always be right and that finding evidence to support or change my decision is important to incorporate into practice. Whether my opinion is right or wrong, what matters most is that my patient receives the best evidence based care possible. When I go to make a call I will pause and think, “Am I choosing this intervention based on protocol, experience, or personal opinion, and what evidence do I have to support my choice?” Hopefully this will lead to better incorporation of current knowledge into practice now, so that it is second nature when I become a nurse practitioner.
Given that yes, nursing does employ a lot of experience based judgments, one way to avoid the effects of heuristics and biases in making those decisions. When a choice is to be made the nurse must look at the evidence first and let that lead to a decision on the intervention rather than diagnose and find the symptoms to prove it. (Kahneman & Tversky, 1974). Documentation of findings, objective, measurable evidence needs to be used in making decisions. There are those gut instinct moments but the nurse should pause, and review the evidence so they can recognize the objective clinical signs that lead to that feeling. It is hard to convince a doctor your patient doesn’t look right if you don’t have vital signs, tests, urine output or other physical evidence to support your claim.
Heuristics and biases can also be removed from clinical decision making by participating in literature reviews, being up to date on best practice and current clinical guidelines and through self-reflection to recognize personal biases and beliefs that may be contrary to best practice. Hospitals have nursing practice committees which serve to make decisions on implementation of policy and procedures, becoming involved in this process and learning how these decisions are made can help the nurse overcome personal biases in decision making and help to prevent biases in hospital policy.

Kahneman D., & Tversky A. (1974). Judgment under uncertainty: Heuristics and biases. Science 185(4157), 1124 – 1131.

Module 3

Don't worry, the only things that got burned were the marshmallows.


My multiple intelligences test didn’t tell me much beyond what I already knew about myself. My highest score was logical-mathematical and my lowest was bodily-kinesthetic. The rest of the intelligences were all pretty similar in score. I am a very logical person and science and math are interesting to me. The preferred form of learning for this style is numbers and logic. I enjoy activities that require deductive reasoning such as Sudoku and minesweeper, and dare I admit it, I actually enjoy math when I finish a long complicated problem with the correct answer. I approach problems with a cause and effect point of view so I seek to fix the cause of the problem first. I view things in very black and white terms, emotions are not something I express easily and are hard for me to read very well in others. I found it no surprise that interpersonal and linguistic were tied for second to last place. Musical came in second on the test and this was somewhat unexpected. I play piano, albeit not very well, and I always have a song in my head. I had never really thought about using musical inclinations to help me with learning. I intrepreted the results to mean that I prefer logical-mathmatical styles of learning but that I can supplement that style with any of the other strengths listed, as one didn't seem to stand out that much farther ahead than another after my top strength. I find this true as I use writing out my notes, flash cards, speaking out loud and rereading when I study for a test.
Technology that could help me with my learning style includes the computer, on-line assessments, practice tests, and case studies, also there are on-line learning modules through my work, through BMJ learning, and the Mayo Clinic to name a few. Using the musical style I could incorporate music into my learning, make up songs to remember details, use music to help me focus, and use my i-pod to download podcasts that have subjects that are interesting to me. I spend much of my day on-line; I can use Google to find information on topics, Face book to connect with friends and colleagues, and email and chat to work on group projects.